Western Shelter Insurance Homeowners Quote
Give us a few details, and we'll be in touch soon!
Your Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Best Number to Reach You At?
*
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
Best time to reach you?
*
8a-11a
11a-2p
2p-5p
Current Mailing & Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How Long Have You Lived at This Address?
*
Less than 5 Years
5 or More Years
If less than 5 years Prior Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is Your Current Residence the One You'd Like to Insure?
*
Yes
No
Physical Address to Insure
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Dwelling to Insure
*
Single Family Home
Mobile Home
Renters Insurance
Farm
Other
Purchase Price, if New Purchase
Current Dwelling Value, if Currently Insured
Previous Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If Currently Insured name of insurance company?
How Many Years Where You Insured There?
Expiration Date of Current Policy, if Known
-
Month
-
Day
Year
Date
Did You Have Any Claims in the Last Five (5) Years?
Yes
No
Please Describe Claim Circumstances & List Any Amounts Paid
Your Date of Birth (DOB)
*
-
Month
-
Day
Year
Date
Your Drivers License Number (DL#)
*
Your Social Security Number (SS#)
*
Whom is Your Employer?
Your Occupation / Official Job Title
Marital Status
*
Single
Married
Divorced
Widowed
Spouse's Name
First Name
Last Name
Spouse's Date of Birth (DOB)
*
-
Month
-
Day
Year
Date
Spouse's Drivers License Number (DL#)
Spouse's Social Security Number (SS#)
How Will Insurance Payments Be Made
Mortgagee Pay
Insured Pay-in-Full
Insured Pay-by-Mail
Insured Pay-by-Electronic Debit
Year Home Was Built
Number of Stories
1
1 1/2
2
Other
Square Footage of Ground Floor
Type of Foundation
Slab
Crawlspace
Basement
Percentage as Slab
Percentage as Crawlspace
Percentage as Basement
WARNING: Percentages of Total Foundation Are Not Correct! Please be sure your foundation percentages input add up to 100%.
Approximate Percentage of Basement That is Finished
Type of Roof Covering
Asphalt
Wood
Wood Shakes
Metal
Other
AGE of ROOF (Important)
*
Date HEATING was last updated
*
Date PLUMBING was last updated
Date ELECTRICAL was last updated
Garage
Yes
No
Garage Type
Attached
Detacted
Auto Capacity of Garage
1 Auto
2 Autos
3 Autos
4 Autos
Other
Square Footage of Garage
Dwelling Construction Type
*
Wood Siding
Metal Siding
Vinyl Siding
Stucco
Brick
Other
Number of Full Bathrooms
*
Number of Half Bathrooms
Kitchen Finishes
Basic
Average
Custom
Flooring
Carpet
Carpet over Hardwood
Wood
Laminate
Vinyl
Ceramic Tile
Percentage as Carpet
Percentage as Carpet over Hardwood
Percentage as Wood
Percentage as Laminate
Percentage as Vinyl
Percentage as Ceramic Tile
WARNING: Percentages of Total Flooring Are Not Correct! Please be sure your flooring percentages input add up to 100%.
Fireplace
Yes
No
Wood Stove
Yes
No
Hot Tub
Yes
No
Pool
Yes
No
Is Pool Within a Locked Fence?
Yes
No
Does Pool Have a Diving Board?
Yes
No
Wooden Deck
Yes
No
Square Foot or dimensions of Wood Deck
Porches
Yes
No
Porch Details
Enclosed
Covered
Open
Other
Square Footage of Porches
Fences
Yes
No
Any Additional Detached Structures such as Storage Sheds, etc.?
Yes
No
Describe & Give Value
Get My Quote!
Should be Empty: